Alcohol Availability and Public Health

Causal Evidence from a Post-Rationing Reform

Tomas Reivinger

05 June, 2025

TODO:

  • Do 1st: read the text directly and time it. Decide what todo after this!
  • Add more bullets to the historical background!
  • fix spelling error in 1st plot.
  • Remove the motivation?
  • Put the double-plots side by side and make them bigger (remove text if needed)
  • The images before the table or NOT in svg format and therefore blurry. fix.
  • Read the tables in the paper and write in significance stars with red ink in case I get asked about it!
  • look at all the plots in the appendix

1 Motivation

  1. It’s a big problem

  2. Limited credible causal evidence

1.1 Big problem

…

1.2 Little causal evidence

  • A lot of evidence for a detrimental effect of alcohol on health

  • Difficult to identify causal …

  • Natural experiments, a fix?

2 Roadmap

  1. Motivation
  2. Roadmap
  3. Historical Background
  4. Institutional setting
  5. Data
  6. Empirical strategy
  7. Results
  8. Further tests (Robustness)
  9. Discussion

3 Historical Background

  • Before Bratt: high levels of alcohol consumption and the 1922 prohibition referendum
  • The Bratt system: a system of individual control (approx. 1920-1955)
  • After Bratt: Systembolaget

4 Institutional setting

Guidelines:

  • 1955-82: Main town to nearest store > 40 km; Population > 5000
  • After 1982: Main town to nearest store > 30km
  • Stated goal of ‘a couple’ new store locations (municipalities) per year1

4.1 A snapshot from 1955

  • No delivery-point sales on the municipality \(\times\) year level

5 Data

  • All cause mortality (1968-2023)
    • Municipality of residence
  • Motor vehicle accidents (1985-2023)
    • Municipality of accident
  • Sales in Liters of (1978-2008)´
    • 100° alcohol

5.1 Municipality reforms and sample restrictions

  • 900 municipalities in 1968, 288 in 1996 (Source: REGINA, SCB)

  • Mortality data aggregated to 1995 municipal borders

  • Martality sample restricted to 1968-1996

6 Empirical strategy and design

The population equation of interest is

\[\begin{equation} Y_{mt} = \gamma_m + \lambda_t + \beta_{mt} \text{store}_{mt} + \epsilon_{mt}\, , \label{eq:pop-eq-of-interest} \end{equation}\]

  • Callaway and Sant’Anna (2021)
  • Long differences with base-period \(t=-1\)
  • Time-invariant controls (population size)

7 Results

  1. Sales
  2. Mortality
  3. Motor vehicle accidents

7.1 Staggered adoption schedule (sales)

  • 1st store test uses municipalities with no store a the control group

  • 2nd store test uses municipalities with only one store as control group1

7.2 1st and 2nd store results

  • 1st store test: positive increase1

  • 2nd store test ATT: 33%2

7.3 Staggered adoption schedule (mortality)

7.4 All-cause mortality

7.5 Population size

7.6 Taking population into account

  1. \(y_{mt} = \frac{\#Deaths}{\#Population}\)
  2. \(\frac{1}{\#Population}\)
  3. Including lagged values of population size

Instead: Callaway and Sant’Anna (2021)

7.7 All-cause mortality adjusting for population size

7.8 MVs

8 SUTVA: definiton

Concern: cross-boundary spillover

Test: define minicipalities with at least one store as treated when the neighboring municipality open a store.

  • Comparison group has at least one store but the neighbour does not open a store.

If SUTVA is violated, there should be a negative effect on sales.

8.1 SUTVA: results

There is indeed some violations of the SUTVA assumption (ATT = 5%) for the full sample.

Using the 2nd store test sample, there is no detectable violations agains SUTVA.

9 Summing up

Caveats:

  • Substitution effect?
    • Moonshine
    • Pickup points (add percentages here)
    • Other sources of alcohol

If we multiply the coefficient on total alcohol sales from the ‘Saturday’ experiment by the number of days Systembolaget is open (today), we get \(0.035 \times 6 = 0.21\), compared to the \(0.25\) from the 2nd store test (column 5).

….

9.1 HonestDiD: Intuition

  • Relative Magnitudes
  • Smoothness Restriction?

Source: https://github.com/Mixtape-Sessions/Advanced-DID/blob/main/Slides/03-violations.pdf

9.2 HonestDiD: Results